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<br />POLICY NUMBER: 200504575 <br /> <br />COMMERCIAL GENERAL UABILITY <br />CG 20 26 07 04 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED <br />PERSON OR ORGANIZATION <br /> <br />This endorsement modifies Insurance provtded under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br /> <br />Name Of Additional Insured Personlsl Or Oraanizatlonlsl <br />City of Santa ArialCDBG, its Officers, Agents, Officials, Employees & Volunteers <br />Comm. Dev. Agency <br />P.O. Box t 98B M-25 <br />Santa Ana, Ca 92702 <br />Primary wording applies <br />Information reauired to comnlete this Schedule, if not shown above, will be shown in the Declarations. <br /> <br />Section II - Who Is An Insured is amended to in- <br />clude as an addftional insured the person(s) or or- <br />ganization(s) shown in the Schedule, but only with <br />respect to liability for "bodily injury", "property dam- <br />age" or "personal and advertising injury" caused, in <br />whole or in part, by your acts or omissions or the acts <br />or omissions of those acting on your behalf: <br />A. In the performance of your ongoing operations; or <br />B. In connection with your premises owned by or <br />rented to you. <br /> <br />,f~) <br /> <br />l~.L) <br /> <br />if; FORM <br /> <br />L/<JL~J~____ <br /> <br />'-,{'-'~:". -.".\y <br />.., "., .""vl..( <br />i:.:: City Aticr:~ey <br /> <br />CG 20 26 07 04 <br /> <br />@ ISO Properties, Inc., 2004 <br /> <br />Page 1 of 1 <br /> <br />o <br />